Summary: Mr X complained about poor care provided to his late father, Mr Y, as part of a Council-commissioned care package. He also says the Council did not respond appropriately to his safeguarding alert. The Council was not at fault.

The complaint

1. Mr X complained about poor care provided to his late father, Mr Y, between October and December 2019, as part of a Council-commissioned care package. He also says the Council did not appropriately respond to his safeguarding alert. He says the poor care caused his father and himself distress and affected his father’s health and wellbeing. He wants the Council to acknowledge there was poor care, apologise to him and write off the outstanding care bill.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
3. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
4. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

Back to top

How I considered this complaint

5. I read Mr X’s complaint and spoke with him about it on the phone.
6. I made enquiries of the Council and considered information it sent me.
7. Mr X and the Council had the opportunity to comment on the draft decision. I considered their comments before making a final decision.

Back to top

What I found

Background information

Standards of care

8. The Health and Social Care Act 2008 (regulated activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The fundamental standards include minimum standards for:
• Person-centred care
• Maintaining accurate and complete records
• Safeguarding from abuse
• Duty of candour.
9. When investigating complaints about the standards of care, the Ombudsman considers if the 2014 regulations and the fundamental standards have been met. If they have not, we consider whether any identified faults have resulted in injustice.

Adult safeguarding

10. Section 42 of the Care Act 2014 requires each local authority to make enquiries, or instruct others to do so, if it believes an adult is, or is at risk of abuse or neglect.
11. A council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has care and support needs which mean they cannot protect themselves.
12. The Council’s safeguarding policy sets out its legal duties and how it will met these, but also says safeguarding procedures are not a substitute for care provider’s responsibilities to provide safe and high quality care and support.
13. The Council’s safeguarding procedure says when it receives a safeguarding referral, it will make initial enquiries to decide if the threshold for a formal safeguarding enquiry under Section 42 of the Care Act has been met. The Council uses a decision-making support tool to assess the potential risks to an individual and to help decide what action to take. If it decides the threshold has not been met, it lists alternative actions that officers may consider, depending on the circumstances of each case. This may include involving other specialists or support services or care management though further assessment or review.

What happened

14. In 2019, Mr X’s father, Mr Y, lived alone and had care needs. After a hospital admission in October, Mr Y was discharged home with a Council-commissioned care package. The Council arranged for a local care provider, provider A, to deliver a care package of fours calls a day to meet Mr Y’s care needs. Mr Y was assessed as a self-funder and paid the full cost of his care.
15. Mr X and Mr Y were unhappy with the standard of care provided and Mr X complained to the Council. Mr Y’s care manager contacted provider A to discuss Mr X’s concerns. Provider A agreed to ensure Mr Y’s call visits were at more consistent times going forward. They also agreed carers would support Mr Y with continence care and ensure they used all the allocated call time to provide support. The care manager rang Mr X to update him on this. Mr X said he would monitor for improvements and contact the Council if there were further issues. The care manager said if things did not improve, they could arrange a meeting with provider A.
16. In December, Mr X met with provider A at Mr Y’s house to discuss his ongoing concerns about poor care. The Council says it was not invited to this meeting and only knew about it after it had happened. After the meeting, provider A updated Mr Y’s care plan to include additional support and rang the Council to update Mr Y’s care manager.
17. A week later, Mr X told the Council he remained unhappy with the standard of care delivered by provider A and was concerned Mr Y may need safeguarding due to the risk of harm. The Council agreed to refer the case to its safeguarding team for further consideration.
18. The care manager spoke to Mr Y. Council records show Mr Y told them he felt the care had improved over the last week. He said the carers were making meals of his choice, attending to his continence care, and washing pots as necessary.
19. The care manager told Mr X if he remained unhappy with the care it could arrange spot check visits or consider whether a change of care provider was needed. Mr X said he would discuss this with his father and then contact the Council again.
20. The Council considered the safeguarding referral. It decided Mr X’s concerns amounted to a complaint against provider A rather than a safeguarding concern, and his complaint was best addressed through care management. It decided the case did not meet the threshold for further investigation by the safeguarding team and closed the case.
21. A few days later Mr X rang the Council to tell it Mr Y had been admitted to hospital. He complained carers had left Mr Y in his chair for over 24 hours. The Council told Mr X the findings of safeguarding investigation and said it would consider whether any further action was needed about this new complaint.
22. The Council contacted provider A who agreed to contact Mr X to discuss his concern that Mr Y had been left overnight in his chair.
23. Mr Y remained in hospital and, following a review of his care needs, was discharged to a care home in late December 2019.
24. Mr Y passed away in April 2020.
25. In August 2020, Mr X complained to the Council. He complained provider A had delivered poor care to Mr Y between October and December 2019. He said because of the poor service Mr Y received and, as executor of Mr Y’s affairs, he did not agree he should pay the outstanding care bill to provider A from Mr Y’s estate. He also complained the Council did not respond appropriately to his safeguarding concerns.
26. The Council commissioned an independent investigation of Mr X’s complaint. The investigator reviewed appropriate Council and provider A records. It did not uphold there was poor care and said the evidence did not support that Mr Y had been left in his chair for 24 hours. The investigator also decided the Council had appropriately considered his safeguarding concerns and fed back the outcome to him within an appropriate timescale. The Council accepted the investigator’s findings.
27. Mr X remained unhappy and brought his complaint to us.
28. In its response to our enquiries, the Council told us provider A could not provide Mr Y’s care records between October and December 2019. It said this was because they had remained in Mr Y’s house when he was admitted to hospital in December 2019 and now could not be found.
29. Provider A was able to send us its swipe system records showing the time and length of carer visits and its office-based records.

Analysis

Poor care

30. When considering complaints, we can make findings based on the balance of probabilities if there is conflicting or incomplete evidence. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
31. The Council has been unable to provide me with Mr Y’s care records, but, on the balance of probabilities, I do not find there was poor care. Social care and provider A’s records show that:
• When Mr X told the Council he was unhappy with the care delivered by provider A, the Council acted appropriately by trying to address his concerns. Provider A agreed to some improvements, which the Council then discussed with Mr X. Mr X told the Council he was satisfied with this and would monitor these improvements and contact the Council if there were further issues.
• Mr X met with provider A in December to discuss his ongoing concerns, but the Council did not know about this meeting until after it happened. The records show provider A agreed to increase the care package and changed Mr Y’s care plan in line with Mr X’s requests. This is what we would expect.
• After the meeting, Provider A acted appropriately by contacting the Council to update the care manager and to request authorisation to increase the level of care in line with Mr X’s wishes. The care manager agreed to this. There is no evidence Mr X told provider A or the Council he remained unhappy after this meeting.
• When the Council spoke with Mr Y in mid-December, he told it the care had improved in the last week since the meeting and carers were completing the required tasks.
• Although the swipe system records show carers did not always stay the full allocated time, overall, carers attended scheduled visits and stayed for the majority of the time allocated.
32. Although Mr X and Mr Y were initially dissatisfied, the evidence shows the Council and provider A worked appropriately with Mr X to address their concerns. Mr Y reported care was improving by mid-December and the carers were completing the required tasks. The Council was not at fault.
33. I cannot know what happened to Mr Y’s care records and, as provider A says they were not in its possession at the time Mr Y was admitted to hospital in December, I cannot say the loss of the care records is provider A or the Council’s fault.

Safeguarding

34. When Mr X raised a safeguarding concern in mid-December, the Council appropriately referred his concerns to the Council safeguarding team. The safeguarding team considered his report in line with its policy but decided there was insufficient evidence to reach the threshold to start section 42 enquiries. It decided the issues raised were more a complaint again provider A and could be addressed through care management. It fed back the outcome to Mr X. The Council considered his concerns in line with its policy and was not at fault.

Back to top

Final decision

35. I have completed my investigation. The Council was not at fault.

Back to top

Investigator's decision on behalf of the Ombudsman